The present invention relates to a therapeutic agent for persistent disappearance (persistent seronegative) of hepatitis B virus (HBV)-DNA in treating chronic hepatitis B.
In particular, the present invention relates to a therapeutic agent for chronic hepatitis B, which induces the conversion of HBe antigen positive to HBe antibody positive (seroconversion), thus efficiently affecting the persistent disappearance of HBV-DNA via a drug administration system (unit) using said therapeutic agent.
Hepatitis B caused by hepatitis B virus (herein after stated as HBV) includes 2 types of hepatitis, acute hepatitis caused by infection in adults (first infection in adults) and chronic hepatitis in the state of persistent infection (carrier) with first infection occuring between a mother and baby, or during the infant stage.
Among these, the first infection in adults causes severe conditions in some, but in many cases, the virus is excluded and the hepatitis is thereby treated, so there is no necessity for antiviral therapy. On the other hand, three types of hepatopathy are observed in HBV carriers which are roughly divided into the following 3 types.
The first type is as follows. In the case of infection via birth canal infection or during the infant stage, the immune response of the host is poor until the host is 10 to 20 years old (immune tolerance), the amount of proliferated viruses is high, HBe antigen is (+), HBe antibody is (xe2x88x92), and the HBV-DNA in the blood proceeds at high levels. At a certain stage, hepatocytes infected with HBV become the target of lymphocytes, and all of the hepatocytes are destroyed. However, this hepatic inflammation stage ends transiently, and the HBs antigen as a viral marker becomes seropositive. Nevertheless, there occurs the conversion of HBe antigen positive to HBe antibody positive (seroconversion), and the HBV-DNA in the blood becomes undetectable. Thereafter, the infection of HBV mutants not capable of producing HBe antigen is persistent in the liver. However, no therapeutic necessity arises in many cases due to the excellent progress of the immune tolerance and since viral growth of most of the carriers is poor, both hepatic disturbances and infectivity are also poor. The majority of the natural progress of HBV is this type.
The second type proceeds with so-called chronic hepatitis activity where the above seroconversion occurs but hepatitis is persistent.
Recently, some carriers of the second type exhibiting a change in GPT even after seroconversion to HBe antibody-positive, have drawn attention because they exhibit multiplication of HBV mutants not capable of producing HBe antigen. In these cases, carriers are seropositive to HBV-DNA persistently or intermittently, and the hepatitis is persistent which may lead to cirrhosis or heptocellular carcinoma.
The third type proceeds with HBe antigen-positive active hepatitis for 5 years or more, leading to cirrhosis or hepatocellular carcinoma.
As described above, the natural progress of HBV carriers proceeds from the HBe antigen-positive stage through the chronic hepatitis B inflammation stage to the HBe antibody-positive stage, and many of the carriers have no symptoms at the HBe antibody-positive stage. In these cases, the seronegative of HBe antigen and the seroconversion of HBe antibody indicate the sedation of chronic hepatitis B.
In some examples, however, it has been reported that cirrhosis has developed by the time of sero-conversion, and thereafter, hepatocellular carcinoma cancer may occur. In some other cases, HBe antibody-positive carriers with no symptoms may undergo severe acute exacerbation of hepatitis or persistent chronic active hepatitis.
Even in the case of HBe antibody-positive carriers with no symptoms, if cirrhosis or conditions near cirrhosis are reached in a period of hepatitis leading to the stage of being HBe antibody positive, there is the possibility that hepatocellular carcinoma occurs depending on how far along hepatic lesions have proceeded. For example, even in the case of carriers being free of symptoms for 10 years or more, there is a case where hepatocellular carcinoma occurred, and there is also a case where the hepatocellular carcinoma occurred within 1 year from initial diagnosis. Thus, even if chronic hepatitis is not active or hepatitis is not active, there is the risk hepatocellular carcinoma would occur insofar as the virus is present in the liver.
A recent study found that an apparent negative reaction to HBs antigen is observed due to genetic mutations in carriers positive to HBs antibody as the infection-protecting antibody. In this case, there is not only the seronegative HBs antigen but also the occurrence of HBs antibody. Further, the HBV is rendered resistant to HBs antibody due to the mutation of an S gene region in the HBV has been reported.
As described above, chronic hepatitis B causes various complicated conditions, as compared with hepatitis C infected similarly and causing cirrhosis or hepatocellular carcinoma.
HBV is elucidated genetically, and its conditions are elucidated in detail along with an effective diagnosis method. Therefore, a wide variety of more effective therapeutic methods have been examined.
HBV, as one kind of DNA virus, is a virus particularly liable to mutation, consequently, there are various mutants and some mutants are found to be closely related to the conditions of hepatitis B.
For example, from the study of the HBV gene, the relationship with genetic mutants observed in the transition step of seroconversion from HBe antigen to HBe antibody and the relationship between severe hepatitis and genetic mutation are also being elucidated.
Along with the elucidation of such an HBV gene, clinical significance possessed by various virus markers is also being examined to make it possible to understand the infectious state and growth condition of HBV so that a therapeutic method for the purpose of viral exclusion against HBe antigen-positive and chronic active hepatitis as described above can be examined.
The final object of chronic hepatitis B therapy is to exclude HBV completely. However, recovery from the carrier state remains almost impossible by any therapy as no accurate established method has yet been developed.
Therefore, sedation of hepatitis by reducing or inhibiting viral multiplication by antiviral therapy to induce the seroconversion of HBe antigen to HBe antibody is carried out as an effective therapeutic method under the present circumstances.
From such a viewpoint, therapy by administration of interferon (IFN) as an antiviral agent has been conducted, and for example, IFN-xcex1 or IFN-xcex2 has been used to improve viral blood disease in HBe antigen positive and DNA polymerase positive chronic active hepatitis.
The therapy of HBe antigen-positive chronic hepatitis B by administration of IFN involves administering IFN once per day or intermittently twice per week. However, it has been reported that, when IFN is administered every day for 4 weeks, seronegative HBe antigen and normalization of GPT, were almost 30% after 5 years in some therapeutic results, while seronegative HBs antigen was hardly observed. Even after IFN was administered intermittently twice per week for 8 months on average, seronegative HBe antigen and normalization of GPT were almost 45% while seronegative HBe antigen was only a few percent.
In view of these present circumstances, the present invention provides a therapeutic agent of interferon (IFN) effective against chronic hepatitis B and further provides a drug administration system for IFN therapy using said therapeutic agent as well as a therapeutic method for chronic hepatitis B by use of said administration system.
As a first embodiment of the present invention, there is provided a therapeutic agent for hepatitis B wherein IFN is divided and administered in 2 to 4 portions per day and the total dosage is a daily effective dosage of IFN.
Further, the present invention provides as a second embodiment a drug administration system (drug administration unit, drug administration method) as a means of treating chronic hepatitis B by use of said therapeutic agent, wherein the daily effective dosage of IFN is divided and administered in 2 to 4 portions per day.
By the therapeutic agent provided by the present invention, as well as by administration of IFN in the specific drug administration system using said therapeutic drug, the persistent disappearance (persistent seronegative) of HBV-DNA is observed, the seroconversion of HBe antigen to HBe antibody is induced, and the effective treatment of chronic hepatitis B with these therapeutic indications is confirmed.
Therefore, the present invention also provides as a further specific embodiment a method of inducing the sero-conversion of HBe antigen to HBe antibody in the drug administration system by use of IFN in said therapeutic agent.
Further, the present invention provides a therapeutic method for the treatment of chronic hepatitis B wherein the persistent disappearance of HBV-DNA or the seroconversion of HBe antigen to HBe antibody is effectuated by the administration of IFN in said therapeutic agent.